UNC’s Department of Medicine Introduces New Telemetry Protocol

Medicine’s telemetry protocol has been replaced by a new model aimed at improving the value of patient care achieved per unit of cost. This is the first project to be approved and implemented by the Department of Medicine’s Value Care Action Group.

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Dr. Michael Craig in the division of hospital medicine is implementing the new telemetry protocol.

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Scott Keller is director of business development for UNC's Department of Medicine.

by Kim Morris, UNC Department of Medicine

Telemetry monitoring is a real-time tool that helps a physician observe the electrical activity of a patient’s heart to identify arrhythmia. Patients wear a portable device on the chest to continuously monitor ECG, respiratory rate and/or oxygen saturations while automatically transmitting information to a central monitor.

However, many patients wear the device for the duration of their care, often staying on telemetry for a week at a time when most only need it for 1-2 days. Staying on telemetry requires resources to monitor. It also interferes with patient mobility. If a lead falls off, an alarm sounds. Nurses looking after patients must know the location of a patient at all times, and with every alarm, a patient must be visualized and assessed.

Michael Craig, MD, MPH, FHM, an associate professor of medicine in the division of hospital medicine is in charge of implementing a new order that allows the provider to determine if a patient meets criteria for telemetry, and the duration of it, for 24 to 48 hours. At that time, physicians can renew the order. But in most cases, it’s no longer needed.

“Cardiac telemetry used outside of the intensive care unit is a significantly overused diagnostic test in cardiovascular medicine,” said Dr. Craig, who has been given protected time to implement the change through the department of medicine’s Value Care Action Group.

“As the idea developed, there was overwhelming agreement among doctors, nurses and telemetry staff. Other health care entities like Rex Healthcare were interested in the same changes. Then the question became how do we get a consensus that will work for all.”

Margaretann House, chair of the orders governance committee and director of the advance practice program with North Carolina Heart & Vascular and Rex Healthcare, was instrumental in helping to scale the initiative for all of the UNC Health Care system.

“This was an ideal opportunity to use the capabilities of technology with an Epic order, encourage providers to practice evidence-based medicine and be able to gain access to appropriate allocation and tracking of resources,” said House. “Dr. Craig and his team did an excellent job navigating the health care system and coordinating efforts among a variety of teams.”

Value Care Action Group

The telemetry project is one of many Value Care Action Group improvement efforts taken up by the department of medicine. Dr. Ronald Falk, chair of the department created the group and appointed champions in each medicine division, encouraging the review of current practices that look for improvements for high-value outcomes in healthcare. High-value is defined by the quality of patient-centered care achieved per unit of cost.

Scott Keller is the director of business development keeping the team focused on value- oriented care models. Dr. Darren DeWalt functions as medical director for the team and helps define the projects. John Vargas is the project manager and Sabrina Vereen uses her experience as a coach within Practice Quality and Innovation to provide additional support.

“The group has someone from every division of medicine championing care value,” said Keller. “The department has made a significant investment in this provider group so that participants can identify and manage their own set of projects to improve both quality and cost.”

The new order went into effect June 13, 2017. Dr. DeWalt says the change at UNC Medical Center is being met with great success.

“Anytime an engrained practice changes, we want to be sure we aren’t forgetting something or making a change that could negatively affect patients,” said Dr. DeWalt. “We also want to be sure to help everyone understand why a change is needed and make sure education is available. These are the safe guards.”